Sunday, 18 April 2010

Critical Reflection Essay

I wrote this essay as my piece for MBBS at Monash. About a month ago. Since I haven't uploaded anything recently, I thought this might be appropriate.

The topic was: write about a learning incident, and critically reflect upon how it helped you grow as a person, and how it'll help you be a better Doctor. This is my response:

As any self-reflexive author would, I begin this piece with a reflection upon the futility of this performance. As suicidal as this preamble does seem, I must also note that I write only with the utmost sincerity, that my recognition of this redundancy itself is not to provoke or stir, but simply to accept, by way of communication, that this exercise is naught but a performance for the reader. But then, what writing is not?

As I strained my eyes on the bright yellow paper outlining the agenda for this report, I looked back at my life, realising that no such pivotal learning moments had in fact occurred. Or rather, worse, that they had occurred but their weight, their significance, was somehow lost upon me in the hyper-real haze of mundanity. This troubled me then, as it does now. However, I cannot help but consider that perhaps it is not so much my history that is at fault, but the dynamics of the very question itself. So often we choose to answer a question without regard of its phrasings, its assumptions - without recognizing that its skewing is implicity subservient to a greater purpose. How can one truly hope to answer a question without that recognition, of what really is being asked? Though I am ill-equipped to answer such a question due to its inherent complexity and the high probability of my ill-interpretation, I do not fail to at least perfunctorily recognize the agenda that does belie this question. We are training to be Health Practitioners, a certain role in society, the importance of which does not escape anyone, especially those who run such training faculties. We are expected to give certain answers to certain questions which are befitting of fulfilling such a responsibility; and furthermore, we are graded on such subjective measures as to how adept, as indicated by this paper, we may be at this task. Though I appreciate the thought and the intent behind this project, I also object to the multitude of assumptions, teleological or otherwise, about how this task is supposed to link to our futures and what it ultimately assesses. That is, I object the ‘utility’ of marking/grading such a paper as an indicator of ‘sensitivity’ of ‘tactfulness’ or a whole host of other such wobbly adjectives which supposedly correlate with ‘good practise’ or general ‘goodness’.

Though I make no assumptions about the marker, I may however imagine at this stage that the above diatribe may seem to some as off-topic, off agenda, and even insincere. Already, the structure of my essay leaves a lot to be desired, especially in terms of the points I should be covering. However, I must herein emphasize that I consider this all as part of the critical exercise. What does it mean to be a good student, and ultimately Medical Practitioner? What are the answers that are meant to be given, and what are the answers that I wish to give – to myself, markers, and society. What is expected?

With such thoughts, and a general sense of unease about life as predisposed by that particular day’s preceding events, I stepped outside into the darkness for a stroll. This night, some week or so before this here moment of its articulation, today, was to be the day. Stereotypically thoughtful, like a walking cliché (how obsessed we are with reality, that we fail to even recognize that clichés are the only truths that we will ever truly own), I held a half-pre-smoked cigar in my left hand, and walked through intermittent darkness abandoned by Churchill streetlights. Still obsessed and frustrated in trying to ‘find’ an epiphany, I realised that epiphanies are difficult to come by, and that potentially, every moment is one in its own right. I decided that this moment, this thoughtful stroll was perhaps most appropriate and also not-appropriate-at-all moment-of-illumination for this exercise. In sum, my epiphany occurred at the moment of my deciding, and came with a warning.

I ‘already’ knew then that all that there was to be thought had already been thought, and all there was to be felt had already been felt, such is life; and all that really remains is rhetorical narrativisation. Life’s mysteries are occluded and confounded only by our childish necessity to narrativise, to tell stories to ourselves about ourselves, as if somehow bareness bars us from ‘being’. The warning was clear. That which I already tasted, smelled, felt, thought, would now be articulated, and in no uncertain terms, but on paper, in writing. That is the nature of this exercise, to make sense, to create links, to connect dots, to conform truths – and that too from a translucent sea of incoherence. Implicit in this recognition and acceptance is that anything that comes forth will necessarily be impure and insincere, as much as anything symbolised ever is. But all that is really required is a charade, a facade of appearances, a reactionary reliving that will pass me for a Health Practitioner, a respectable one at that.

[If the marker may allow me to deviate and fulfil the allocated task], then, it was at that moment in my life, that I realised that perhaps I need not be untruthful, or at least be not as untruthful, and instead write with sincerity (though still performative) about how it is that I feel. That is, I need not contrive and hyperbolize a particular ‘real’ situation to appease the system. The narrative which comes forth from here may be less ‘truthful’ in the factual sense of the word, however, in another all together more meaningful sense of the word, these impending ‘lies’ may in fact be more deserving of the ink on this paper than any corollary factual accounts.

That in itself is a learning experience, in that it is always better to tell lies with which you can live than to tell truths which you cannot prove. Telling a lie is at the least sincere, the act therein implicitly recognizes and accepts falsehood and that alone is immensely valuable. Whereas, telling ‘truths’, (the subjective ‘ideal’ as opposed to factual), in the service of certain imagined, illusory virtues, almost certainly smacks of arrogance and further ignorance of lived-consequences. Lies involve foresight, sensitivity, tactfulness, an understanding beyond virtue and value of one’s effect on this carefully unbalanced world. Whereas, truths, that most chimerical of constructs involves at most a self-congratulatory applause at ‘doing the right thing’, a nod to self, appreciating self-indulgence without consideration and appreciation of the opacity of life. (I write as if ‘life’ is a concept soluble in singularity).

My walk continued in solitude. My thoughts sunk low and spiralled through my body as if gravitating towards some mystery in my gut; a metaphor matched and mimicked visually by the smoke exhaled from my puckered lips under the far reaching shine of the streetlights.

What strikes me now about that moment is its inherent foresight. That I anticipated this moment of articulation to occur while ‘being’ in that particular present. That articulation of bareness of reality is only ever withheld, and occasionally spewed forth in moments like this. I had understood then that the very epiphany I was not having then, would be, and only ever can be had in articulation where it will be reinvented, re-realised, and reimbursed in full. And that is the way that one learns in life; even during the most testing, enduring phases of life, we only ever look forward, for that is the only direction we are offered. We are allowed the present so as to plan our futures, to lament our predictions and potentials. The present exists only for grieving our lack of immediacy. In reflection of that walk, I feel now that truth exists only at the moment of articulation, in instantitiation and through a revisioning of the past. Our actions are only ever understandable in instances and thereby justifiable only in lies through our (hi)stories. I bring this up as I wish to discuss my decision to take up Medicine as a profession.

In no way did I take this decision lightly; I knew the implications and responsibilities, foremost for my life, and also for others’, in which I would necessarily have an impact in this profession. However, as unfashionable for a Medical student to admit as it is, I must add that Medicine is not my passion. I did not have a moment of clarity or a sudden thunderbolt, which pulled me towards the field; I do not consider this to be it. (I am almost, tentatively, hesitantly, certainly unsure, that there is much more to life than this, and I plan to find out where it is and why it has not been talking to me). I personally am of the opinion that this admission, as filled with guilt as it is, will help me ‘be’ a better Health Practitioner. To connect the dots with the earlier mentioned performativity (that is, lying), I argue (with myself of course!) that to be feigning is more sincere and fruitful an endeavour than to ‘being’. However it is not passive feigning, not one rooted in self-deceit, but rather it is one anchored into an ideal. A conscious acceptance forthright of one’s limitations is better than the deceit of ‘being’, as that is not a true option, it’s a delusion - a delusion which leads to apathy and self-aggrandisation. Thus, for me, I realised ‘then’ (that which I already knew) that to be a good, responsible, societally acceptable Medical Practitioner, I would have to live up to, and construct myself as an ideal. The effort will be ever frustrating, and failing, but at the same time, it will be sincere and disillusioned. To maintain a measure of distance is perhaps the most important trait of a prospective Medical Practitioner - one acutely aware of his determinants and relations to the past. One who is able to see the underlying structures lining his actions, as relative to, and independent of, his past.

Thus, even as exemplified by this exercise, we realise that to articulate now is to realise in this instant that the past binds us in uncertain ways. It is relevant only insofar as we may choose to refer to it for the sake of narrative. A real sense of responsibility thus dawns upon me in this recognition. This responsibility is at once fleeting, freeing and somewhat disturbing. A sense of personal responsibility means that it is not sufficient to refer to ones history as causative of one’s decisions. This is more so important in terms of perceptions; all that we ever offer to the world will be judged in isolation, in instances. This is not simply because people fail to understand context, but more so because the concept of context itself is inherently unstable.

Being watched from the vantage of a crow sitting atop the streetlight under which I loitered, it became evident to me that we exist at all only in discrete moments, tentatively threaded to our past, obsessively consolidating our identities.

Is this true only from the Other’s perspectives? I fear not. We only ever ‘consolidate’ when that gaze of the Other is lifted from above us, when we are allowed to ‘be’. At all other moments we are discrete, fragmented, conformed. Thus to ask for forgiveness/absolution of our actions is to not understand our truly disconnected nature from ourselves. The only logical conclusion thus is that there exists such radical freedom in and of oneself that it is inherently suffocating. Only in ‘performance of self’ is there real structure. We are chronically responsible for our actions, and must hold ourselves accountable for them in spite of our pasts, and accept full responsibility only as we could expect of others. Only in this realisation, this self-othering, can there be ‘true’ fulfilment of social duties, however trivial, fleeting and ultimately value-void they may be. By choosing the path of a medical practitioner, I choose to behave a certain way, to conform and to exist as expected by the Other, and to not do justice to this role is not only insincere to society but also damaging to one’s dignity.

As I drew my walk to a close, I anticipated this moment of closure in my exercise. I had also pre-planned that I would undo my thoughts by recognizing the problems of these articulations. The theme which I have tried to expound herein is that things only become ‘active’ upon certain symbolisation, upon utterance, and this exercise too has proven this, at least to myself. From where I stand now, and looking back 2000 words, I find it astounding, that which I have performed, that which I have uttered. The conviction with which I concluded the second paragraph now seems somewhat unstable. What is that not but development? The ‘truth’ of the statements is at best secondary, but their instantiation, their viscerality is primary. Only through action, through commitment can there be change in self. That applies too to my education here at Gippsland; whatever the doubts now may be, or wherever they may originate, the primary goal is application. Whichever direction that may lead towards will determine, in discrete portions, how I develop (even if un-teleologically) as a medical practitioner, and more importantly as a person. In sum, to learn is to act.

I opened the door to my room, sat on the chair and realised that I had no (k)new knowledge, but had learnt much.

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